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In the final scene of the Wizard of Oz, the dog Toto pulls back the curtain and Dorothy discovers the man behind the curtain is not the great and powerful Wizard, he’s just a little old man with a megaphone. Sometimes, actions in Washington use the megaphone but there is relatively little “behind the curtain.” That’s how the new rule on Association Health Plans (AHPs), issued by the Department of Labor, feels.

It was with great fanfare that the Administration issued new rules for AHPs. WIPP has supported AHPs since its inception as a necessary tool to allow small businesses to band together to create larger health insurance pools, thus creating more competition and better prices in the small business marketplace. Insurance rules adopted during the Affordable Care Act (aka Obamacare) largely prohibited AHPs from a viable option. Because every insurance plan had to cover 10 “essential health benefits” under the ACA, these plans became mute.

When the Department of Labor announced loosening the regulations to allow AHPs, we applauded. WIPP submitted comments urging better pooling mechanisms, a wider range of health plan options and protections for those with pre-existing conditions. We also urged the Department to include a different “commonality of interest” definition, allowing small businesses to band together beyond a trade, industry, or profession. This would have allowed small business organizations to offer AHP membership to its members, including WIPP.

On June 21, the man behind the curtain showed up. The Department of Labor issued its new AHP rules. By deciding to keep the definition of who can join an AHP to a trade, industry, or profession, business organizations like WIPP, cannot offer an AHP. For example, an accountant in Nevada could join an AHP housed in a national association of accountants, but an organization of women business owners, does not qualify as a trade, industry, or profession, according to the new rules. The AHP can have out-of-state members but must comply with the rules of the state in which it is housed, restricting its ability to be a true “across state lines” option. Important to note is that AHPs are not required to offer the 10 essential benefits, which means education for employers and employees who join AHPs is needed.

News reports suggested that small business associations who have supported AHPs in their policy platforms are not going to take advantage of the new rules. That’s because they can’t—their commonality is business owners, not limited to a specific trade, industry or profession. Giving small business owners more health insurance options continues to be part of our policy platform. As premiums continue to rise, small business exchanges set up by the ACA should not be the only option. The Department of Labor could have done so much more than use their megaphone.

Due to a move by the Trump Administration, the Department of Labor released the final version of its Association Health Plan rule, which allows industries and small businesses to band together via bona fide associations to buy insurance as part of a plan to encourage competition in health insurance markets and lower the cost of coverage. AHPs will be an important part of employer options for coverage beginning in 2019.

The Association Health Plan (AHP) rule broadens the definition of an employer under ERISA, the Employee Retirement Income Security Act, to allow more groups to form association health plans across state lines, similar to large employers. Key provisions in the final AHP rule include:

Expansion of definition of those that can form an Association Health Plan (AHP) – An association that represents a single trade, specific industry or profession can now establish an AHP that provides coverage to their members across the entire country, like a large employer plan. General business organizations and workers, or business owners in unrelated professions can band together to obtain coverage through an association health plan, but they must be in the same geographic region. While this allows for a breadth of types of AHPs – national, statewide or local – by restricting criteria of commonality to establish AHPs across state lines, many existing national associations will be unable to set up AHPs and provide access to affordable insurance options to their members.

Association Health Plans (AHPs) can bypass certain requirements of the Affordable Care Act (ACA) – AHPs do not have to meet ACA essential health benefits requirements, thus they do not have to cover all the benefits that are currently required in the health insurance plans presently sold in the state exchanges. While this will allow AHPs more flexibility in customizing plan options, and likely result in lower premium costs, it is important for business owners and workers to note that these plans will likely offer less comprehensive coverage.

Association health plans cannot restrict membership based on health status or charge sicker individuals higher premiums – An AHP will operate like a large employer plan and includes nondiscrimination rules ensuring the association cannot deny coverage to anyone that meets their membership requirements and wants to purchase coverage. AHPs can adjust premium costs of members based on age, which is similar to age rating rules in current ACA health exchanges.

WIPP has supported the implementation of AHPs as an effective mechanism for small businesses to pool together to obtain affordable health insurance. WIPP submitted comments to the Department of Labor on the proposed Association Health Plan rule, highlighting that WIPP believes that a successful healthcare market should encompass three core principles: an effective pooling mechanism, a wide array of health plan options, and a protection in place for those with pre-existing conditions.

In addition, WIPP recommended including an additional criterion for commonality of interest to allow employers to band together for the purpose of establishing an AHP through a membership organization or association that is comprised of members regardless of whether they are in the same trade, industry, line of business or profession, and regardless of whether they are located in the same area. Unfortunately, as highlighted above, the Department of Labor did not agree with this more expansive view, leaving national business organizations like WIPP unable to set up an AHP across state lines.

The Department of Labor shared a fact sheet on the new rule that noted important dates for associations or business owners interested in AHPs:

All associations (new or existing) may establish a fully-insured AHP on September 1, 2018.

Existing associations that sponsored an AHP on or before the date the Final Rule was published may establish a self-funded AHP on January 1, 2019.

All other associations (new or existing) may establish a self-funded AHP on April 1, 2019.

Although the Affordable Care Act envisioned state exchanges rather than AHPs, WIPP believes there is room for both. Though the Obamacare Exchanges initially gave small businesses more coverage options, many plans have dropped coverage, leaving the small business market with fewer coverage options and premium costs have risen year over year. The expansion of AHPs would provide more cost-effective coverage options for small businesses and the self-employed.

It’s a favorite phrase of my boss – and WIPP’s Chief Advocate – Ann Sullivan. The idea is nothing new: a simple solution is usually the best. That is why, for years, women business owners used the simplest possible idea for providing health benefits – you (employee) go out and get your own insurance and I (employer) will reimburse you. Simple, right?

They are called Healthcare Reimbursement Arrangements, or HRAs, and bringing them back (for the second time) is one of WIPP’s top healthcare priorities. We are making great progress. The House Ways and Means Committee approved legislation that would allow HRAs to be used for firms with fewer than 50 employees. The House as a whole is expected to vote on the bill next week.

The bill would allow employers to reimburse employees for qualified medical expenses like premiums and out-of-pocket costs. Importantly, employers must offer it to all eligible employees and cannot offer a separate group plan. The reimbursement is capped at around $5,000 for an individual and $10,000 for families and does not count as employee income (meaning no taxes!).

Again, the idea is simple. Employers select an amount to reimburse employees, instead of locking in an insurance plan that may not fit their employees or their budget. But why did we lose HRAs in the first place? That is not so simple.

The Affordable Care Act eliminated caps on health insurance plans—an undoubtedly good thing for when disaster or disease strikes. But, in the opinion of the IRS, these HRAs, by definition, had a cap (however much the employer contributed). So they were outlawed in 2013 or 2014.

2013 or 2014 is a strange way to describe when the IRS banned a certain healthcare plan. But that is what it was – the IRS notices on the issue were so confusing they had to issue additional regulations three times. Policy wonks, insurers, and healthcare consultants were unsure – let alone business owners – about whether they were allowed. And making a mistake on this carries severe penalties; offering a non-conforming plan can trigger a penalty of $100 per day per employee –more than $350,000 a year for a company with 10 employees.

Because of this confusion, WIPP stepped in asking Secretary Burwell to intervene on behalf of women business owners. She did and HRAs were allowed through June 2015. Legislation is needed to bring them back permanently and WIPP is optimistic Democrats and Republicans can work together, as they already have, to get this done. After all, ten million women business owners and their nearly nine million employees are pretty active voters.

It’s pretty simple.

More on how WIPP is working with Congress and the Administration to bring competitively-priced and accessible health options to women business owners is in our blog, Making the Affordable Care Act Work.

Is it just me or are the candidates ignoring economic issues that are business women’s bread and butter? The election so far has largely centered on social issues and impossible promises such as free college. What about taxes, healthcare costs, employee issues, access to capital and access to markets? And what about a positive message? Business owners are optimists – if they didn’t believe America was great, they wouldn’t take the risk of investing in a business. Someone out there thinks America is still the land of opportunity—to the tune of 10 million women business owners.

In all my years of working with Congress and Administrations, Republican or Democrat, WIPP has always taken the view that women who are business owners are influencers in their communities and a trusted source of information. Their focus is on results, sensible regulations and an investment in small businesses. Therefore, they have the obligation and privilege to make a difference in elections and policy platforms.

Hence, the launch of WE Decide 2016, a collaboration with Personal BlackBox (PBB). WIPP has provided a platform for women entrepreneurs to have their voices heard during the 2016 elections. WE Decide 2016 engages women business owners and women entrepreneurs to focus our message. The opinions shared through this initiative will culminate in a policy platform, which will be shared with the candidates at both national conventions.

WE Decide 2016 utilizes an interactive online platform to conduct polling and outreach to women business owners on the issues that affect our lives and businesses everyday. Through quick polls and issue surveys, we will be able to ascertain women business owners’ views in a timely manner and we will share the results with the media.

What makes WE Decide 2016 different from all the other avenues to share your opinion? Thanks to our partner, Personal BlackBox, WE Decide 2016 gives women control of their personal data and a safe place to express opinions privately with peers. Unlike current Presidential polls run by CNN, the DNC and RNC and even Facebook, the information you share with WE Decide 2016 will never be sold to anyone.

So, let’s get started. First step: go to WE Decide 2016 and register. We need an initial number of 1000 registrants to do credible polls. Step Two: ask all of your friends and networks to join the effort. Since we are 10 million strong and an economic force, women business owners are in a unique position to shape the conversation around issues and approaches that resonate with us.

Does anyone else think the 2016 Presidential election has been going for ages? It sure seems like that to me, but admittedly, it has been one of the most entertaining primaries in recent history. The 24-hour news cycle has kept us up to the minute with every speech, gaff, or barb traded by the candidates. We’ve seen our fair share of debates, roundtables and town halls while watching almost daily polls track the candidates as their support rises and falls. Luckily, today is when the rubber meets the road – at least in Iowa – where Iowans will caucus for their primary candidates. As the 2016 Presidential election ramps up, so too will WIPP’s advocacy efforts. Why? Because we are not cynical about democracy and the process necessary to achieve it. We believe engagement is the mechanism by which to change the trajectory of our country’s future.

WIPP has made addressing the needs of women entrepreneurs a top priority for elected officials and our advocacy has resulted in successes for women business owners. Just look to 2015 for proof that women business owners have a seat at the table. We worked for implementation of sole source authority for the Women-Owned Small Business (WOSB) Procurement Program– a tremendous step forward for women-owned businesses seeking to win federal contracts. The Senate Small Business Committee passed the first reauthorization for the Women’s Business Center (WBC) program in nearly a decade, which provides important business support to women entrepreneurs. These are just two of the many policy victories for women entrepreneurs last year.

To ensure that we keep up that momentum and women entrepreneurs remain a top priority for our elected officials, WIPP has launched WE Decide 2016. This collaboration with Personal BlackBox (PBB) will engage women entrepreneurs seeking to affect the issues candidates discuss throughout the 2016 Election. Ten million woman business owners, if active, are in a position to influence the direction of economic policy positions. According to the National Women’s Business Council (NWBC), women-owned businesses are an economic force, contributing nearly $1.6 trillion to the annually to the US economy. The WE Decide 2016 platform seeks to engage all women business owners and associations whose members are women entrepreneurs, not just WIPP members. When women come together to share their views about the future of this country, they don’t need to be caucusing in Iowa or attending town halls in New Hampshire. The platform will be polling women business owners on economic issues, such as access to capital, access to federal markets, tax policy and providing healthcare to employees, to mention a few topics that affect us daily.

As the primary results come in and we move on to the New Hampshire primary next week and the South Carolina primary on February 20, know that through WE Decide 2016, we have a unique opportunity to engage the voices of ten million women business owners. We certainly don’t need to agree on every issue, but I, for one, think women business owners may not necessarily possess the same views on issues that the national polls indicate. So, lean in and let’s see the results of our engagement. I can’t wait to see the impact all of us together can have in November.

It’s time to get covered! Millions of Americans count on HealthCare.gov for quality and affordable health coverage. If you or someone you care about needs health insurance, you should know that Open Enrollment for 2016 coverage runs from November 1, 2015 through January 31, 2016.

Learn about options available in your area by visiting HealthCare.gov or call 1-800-318-2596.

Key Dates and Deadlines

November 1, 2015: Open Enrollment for 2016 Marketplace coverage begins.

December 15, 2015: Deadline to enroll for coverage starting January 1, 2016.

January 15, 2016: Deadline to enroll for coverage starting February 1, 2016.

January 31, 2016: Last day of Open Enrollment for 2016 Marketplace coverage.

Although the vast majority of employers will not be affected, you should determine if you are an applicable large employer. If you averaged at least 50 full-time employees, including full-time equivalent employees, during 2014, you are most likely an ALE for 2015. If you have fewer than 50 full-time employees, you may be considered an applicable large employer if you share a common ownership with other employers. As an applicable large employer, you should be taking steps now to prepare for the coming filing season.

In 2016, applicable large employers must file an annual information return – and provide a statement to each full-time employee – reporting whether they offered health insurance, and if so, what insurance they offered their employees.

If you will file 250 or more information returns for 2015, you must file the returns electronically through the ACA Information Reports system. You should review draft Publication 5165, Guide for Electronically Filing Affordable Care Act (ACA) Information Returns, now for information on the communication procedures, transmission formats, business rules and validation procedures for returns that you must transmit in 2016.

The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA – is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The legislation includes a long list of health-related provisions that began taking effect in 2010 and will “continue to be rolled out over the next four years.” Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs and improve system efficiency, and to eliminate industry practices that include rescission and denial of coverage due to pre-existing.

What does it mean for business today?

Business With 50-99 Employees 2015

Key Point #1

Navigating through transition relief to determine the date you need to make sure you are in compliance.

Applicable large employers (ALEs) with fewer than 100 full-time employees, including full-time equivalent employees, may have until 2016 to offer health insurance to eligible employees and their dependents without facing penalties.

This transition relief is available to employers who can certify that they have not reduced their workforce to remain under the threshold and have not materially reduced or eliminated health coverage previously offered. This certification needs to be included with your filing under Section 6056 for 2015.

The IRS will still grant transition relief to employers who reduced their workforce for “bona fide” business reasons.

Key Point #2

If you are over 50 FTE (Full-Time Equivalents) or part of a control group (Parent Company) with more than 50 FTE than you MUST file the 1095-C and 1094-C even if you do not offer coverage.

Key Point #3

Don’t “expect” your payroll company to complete these 1094-C and 1095-C forms.

Why? Most payroll companies don’t even track the information required to complete these new IRS forms—It is more a benefit enrollment and plan design function than payroll.

Dates of hire and waiting periods determine when employees are in the limited assessment period. Partial months are treated uniquely differently than full months and the series coded will change. Most payroll vendors only track deductions.

Termination, rehire dates and class changes impact offer of coverage and safe harbor designations. Employees with a number of changes during the year can see a variety of different codes appearing on form 1095. Not a payroll function

Offer of coverage determines whether 70% (2015) and 95% (2016) levels are reached or significant penalties are to be paid. Not a payroll function

Safe harbor designations and income drive affordability calculations. Not a payroll function

Transition relief provides the ability to mitigate risk and avoid penalties altogether. Not a payroll function

Key Point #4

Start balancing culture and cost now because the “Cadillac Tax” is on the horizon in 2018—It’s not a matter of “IF” we hit the Cadillac Tax it’s a matter of “When” we hit the Cadillac Tax.

If health insurance exceeds $10,200 in premiums for an individual or $27,500 for a family. The tax amounts to 40 percent of the cost above that threshold AND its Non-Tax Deductible.

Why do we say “When” we hit the Cadillac Tax? The insurance cost threshold ($10,200 in premiums for an individual or $27,500 for a family) only increases at CPI each year which is about 3.1% and Healthcare inflation increases close to 8.0% thus the X & Y axis lines are eventually going to cross.

Please join us September 29th for Women Accessing Capital: 5 Things You Need to Know About the New 1094-C and 1095-C IRS Reporting. Register now!

We sat down with Tracy to hear more about her business and her relationship with WIPP:

Tell us a little about your company and its mission.

FSR was started with the desire to help our wounded warriors heal and to provide healthcare personnel with the clinical expertise to our military treatment facilities and VA hospitals around the country.

Have you always been an entrepreneur? If not, what, or who, inspired you to take this leap?

I was a Registered Nurse with 25 years of ICU and Trauma nursing experience. I had the opportunity to work at Walter Reed Army Medical Center as a government contractor. This exposure provided me the ability to care for individuals who had sacrificed for our freedoms, hear their stories and meet their families. I was encouraged to start a business that could provide more than just my expertise at the bedside and also be an employer of best in class healthcare professionals that had the same passion as I did.

How has your background in Healthcare helped develop and grow your company?

As a RN, I understood the environment that I was placing our professionals in. I could speak the same language, however, learning the business of government contracting was a challenge as my background was in patient care. I was working nights as a RN at Walter Reed and during the day, I was focused getting business, writing proposals and learning about government contracting.

Do you have a contracting success story that you are proud of?

There is not one contract that I am more proud of than the others, however, none came without sacrifices and hard work. Once you receive a Government contract, your goal is to exceed your customer’s expectations and gain outstanding performance ratings. Having gotten my 8(a) certification within the same year as I started FSR (through a waiver), has helped me a great deal, although it took 18 months of hard work and complete dedication before I got my 1st Government contract.

Tell us about your experience as a WIPP Member? What resources/value has WIPP provided that has been helpful to you and your company?

WIPP has provided me with the education on policy and what is going on in government contracting in a concise fashion. There is a lot of material to read and learn about, however I can go to a single website and find out what is going on. I was so excited that WIPP was so instrumental in getting sole source opportunities and specific set asides for WOSB!

According to Forbes, Elizabeth Holmes has been named the world’s youngest self-made female billionaire with a net worth of $4.5 billion. Earlier this month she was named as Time Magazine’s List of 100 most influential people. Her billion dollar idea?: a revolutionary way to make blood testing accessible for anybody. Holmes’ company, Theranos, created a system that brings together a minimally invasive and needle free method of blood withdrawal with hundreds of low cost tests that almost anyone could afford. Holmes’ intention is to restructure our healthcare system to be more preventative as opposed to a reactive:

“The current health care paradigm is one in which diagnosis often takes place after symptoms are already present, and diseases have begun to progress. We’re committed to changing that. We’re pioneering a new paradigm in which lab testing is accessible and affordable for everyone. When cost is no longer a consideration and people no longer have to be symptomatic in order to get a test. Meaning your patients can get the tests they need, and you can get the information you need, early and in time for therapy to be effective.” – Elizabeth Holmes, Theranos website

Holmes attended Stanford University but dropped out at the age of 19 to start Theranos in 2003. Since then, Holmes has impressed investors with the potential commercial, military, and humanitarian applications of her idea. Holmes has also acquired a very impressive board of directors, including former cabinet secretaries George Shultz, Bill Perry and Henry Kissinger, two former Senators, a retired CentCom commander, a retired Navy admiral and a former director of the Center for Disease Control and Prevention. She has rapidly developed her company since 2003 and has notably partnered with Walgreens to build thousands of Wellness Centers for Theranos to carry out its testing. To date, Theranos has also accumulated $92 million in venture capital funding from investors like Larry Ellison and Draper Fisher Jurvetson with her first venture capital funding worth $5.8 million in 2005 at the age of 21. Holmes owns 84 patents to her name and Theranos is estimated to be worth $9 billion with Holmes owning half of its stock.